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Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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Percutaneous left atrial appendage closure: data from the real world
Session:
CO1 - Cardiologia de Intervenção
Speaker:
Carolina Saleiro
Congress:
CPC 2019
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.3 Non-coronary Cardiac Intervention
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Carolina Saleiro; João Lopes; Rogerio Teixeira; Diana Decampos; Luís Puga; Joana M. Ribeiro; José Pedro Sousa; Luis Paiva; Marco Costa; Lino Gonçalves
Abstract
<p><strong>Background: </strong>Atrial fibrillation (AF) is associated with high thromboembolic risk, which can be reduced by anticoagulant therapy. In patients with contraindication to oral anticoagulants (OAC) or therapy failure, percutaneous closure of the left atrial appendage (LAA) is a promising therapy.</p> <p><strong>Aim: </strong>To assess the feasibility and safety of LAA closure in patients with contraindication to OAC or OAC therapy failure.</p> <p><strong>Methods: </strong>128 consecutive patients who underwent LAA closure between May 2010 and November 2018 were included in the analysis. Short-term follow-up was done at 7 days and long-term at 20±21 months.</p> <p><strong>Results</strong>: Mean age was 73±8years old, with 63.3% male patients. Previous history of stroke/transitory ischemic attack or coronary artery disease was present in 35.2% and 14.8%, respectively. Moreover, a third of our patients were diabetic and another third had chronic renal failure. The mean CHA2DS2VASc stroke risk score in this population was 4.4±1.4 and the mean HAS-BLED bleeding score was 3.0±1.0 (≥3 in 67.2%). The main indications for LAA closure were: major bleeding (53.9%), high bleeding risk (20.3%), embolic events while on OAC therapy (15.6%) or recurrent minor bleeding (12.5%). The procedural success rate was 96.1%. It was guided by transesophageal echocardiography (52.3%) or intracardiac echocardiography (ICE) (51.6%), with a predominance of ICE in the last 3 years. The most used device was Amulet (63.5%), AMPLATZER Cardiac Plug (25.4%) and Watchman (11.1%). Cumulative complications rate at 7-days follow-up was 14.8%, including one death. One patient had a thrombus in association with the device. 11 patients were dead during long-term follow-up. Embolic and bleeding events were less frequent than expected from the observed CHA2DS2VASc (expected stroke rate/year 5.6% vs observed stroke rate/year 0.5%; 91% risk reduction) and HAS-BLED (expected major bleeding rate/year 4.7% vs observed major bleeding rate/year 2.1%; 55% risk reduction) scores.</p> <p><strong>Conclusion: </strong>According to our data, LAA percutaneous closure was feasible and safe. The procedure seems to offer a significant ischemic and bleeding protection for high-risk AF patients.</p>
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